For quite some time now, the discussions around the microbiome of the skin also have reached the intimate body areas. It has become apparent that body hygiene and body care are not only advantageous but also can be counterproductive to some extent. Men and women alike should know about the details that matter.

High local skin and air moisture and body warmth combined with the bodily secretions determine the microclimate of the genital area. More or less closely fitting textiles also play a part in making the area a very attractive target for all kinds of microorganisms. In the course of evolution, the human body has adapted itself to the situation by producing antimicrobial peptides (AMP), continually reproducing secretions, arranging with certain types of microorganisms and even entering into a symbiosis with them. Depending on the specific flora, a characteristic and typical pH-value of the body area evolves and non-resident external microorganisms are successfully kept out - a finely tuned balance that ensures physical integrity. Every unscheduled external influence disturbs the balance. This, of course, also applies to hygiene and skin care preparations with various compositions. It is recommended to carefully consider the kind of products to use for the treatment and the kind of products to omit in this case.1

Male and female intimate care

Other than the male hygiene and skin care that usually does not change for long periods of time, the female intimate care has to be adapted to hormonal imbalances involved with the monthly period as well as with puberty, pregnancy, lactation period, menopause and the subsequent symptoms of old age. Every one of these bodily states is challenging and women have the possibility of taking good care of their skin but also of making a lot of mistakes.

Appropriate cleansing

Cleansing preparations such as soap bars, liquid soap or shower cream are not always necessary. When they are used, it is recommended to avoid irritant emulsifiers and tensides. The preservatives of the Cosmetic Directive, some of them are suspected of being endocrine disruptors, should also be avoided with regard to the female intimate flora. In the case of atopic skin and perianal barrier disorders, care has to be taken that the products do not contain surface-active re-fatteners. In these cases it is preferable to apply skin barrier-identical substances in the form of lamellar creams or non-aqueous oleogels in the anal area. In case that skin or mucous membranes are irritated due to frequent cleansings, it is advisable to use vegetable oils for the cleansing similar to the baby care. Avocado oil for instance can be used for cleansings but also for the subsequent skin care. The fatty acid spectrum of the oil and the phytosterines contained are a good match for the physiological conditions of the skin. In the case of barrier disorders, the water should be tested for hardness components since they react with the cutaneous fatty acids and intensify the disorders through formation of calcium- and magnesium salts. The pH values of the cleansing products can be neutral up to lightly acidic. It is not required to adapt the preparations to the acidic milieu e.g. of the vagina (pH 4) since the preparations are immediately washed off with water and since the cleansing should be limited to the external parts of the genital organs. It often is sufficient to just use plain water without any additional products for an appropriate cleansing.

The adequate skin care

Since the genital area is well equipped with sebaceous glands, there often is no need for fatty creams. However, if the application of such creams is indicated, emulsifier-free creams are preferable because their lipid substances are adapted to the natural conditions of the skin, similar to the facial care of sensitive skin. Preservatives have counterproductive effects also in this case. The pH level of cream preparations with a high content of buffer substances (phosphates, citrates etc.) should be adapted to the pH of the areas to be treated. In creams containing small amounts only or no buffer substances at all, the pH of the preparations only plays a minor role since the buffering capacity of the skin will immediately adapt the physiological pH level. Oleogels based on phosphatidylcholine penetrate fast into the skin (see above) and thus can be beneficial for the skin care in the sensitive anal area. They are advantageous insofar as they also have anti-irritant effects and do not require counterproductive cosmetic additives due to their non-aqueous formulations. Small amounts of oleogel, suppositories or avocado oil also are appropriate lubricants in the case of vaginal dryness as they will neither affect pH nor vaginal flora due to their excellent tolerance. It should however be mentioned that they are not compatible with every condom on the market. Aqueous xanthan gels (food additive E 415) are a condom-compatible alternative. The polysaccharide powder freshly mixed with water in a dosage of 2 to 3% is a stable and absolutely non-irritant gel without scent or taste and without any additives whatsoever. It should however be freshly prepared in order to avoid bacterial contaminations during storage. A third alternative are unpreserved hyaluronic acid preparations which frequently are stabilized with glycerin or glycol for microbiological and allergenic safety. Attention should also be paid to the fact that the skin care preparations do not contain perfumes since they can often cause unwanted reactions in the case of sensitive skin. Alcohol denatured with phthalic acid diethyl ester (INCI: Alcohol denat.) should definitely be avoided in the context of intimate care. A tip for women who persist on using refreshing fragrances in the genital area: apply them onto the underwear where they also are effective and cannot do any harm. Ingredients such as mineral waxes, paraffins and vaseline (petrolatum) also are counterproductive substances since they remain on the skin surface, intensify the humid and warm conditions by reducing the transepidermal water loss (TEWL) and possibly cause unwanted skin swellings.

Too much skin care

A lot of problems arise from the idea that the genital area should be clinically clean and that possibly developing odours have to be fought immediately. This often results in treatments like vaginal douches which are counterproductive since the natural balance will completely be disturbed with exactly the consequences that were intended to avoid. This finally triggers a vicious circle with the result that facultative pathogenic germs will thrive, spread and finally enter into the genito-urinary tract. It leads to itching, burning sensations and irritations. The then occurring fishy odours emanating from amines, as for instance trimethylamine, indicate a disordered microbiome or even are a symptom of infections. Inappropriate bactericidal vaginal sprays, deodorants, sanitary pads and hygiene wipes to cover the body odours create even more confusion in a once natural balance. In addition, bactericides and perfume components can penetrate into the unprotected mucous membranes or skin parts of this sensitive area and can have allergenic effects. It is recommended to refrain from most of these seemingly advantageous tools; they should not be used in the genital area. A tip: Throwaway facecloths moistened before visiting a toilet can be helpful outside the home.

Clothes & culture

Since body accentuation is an essential part of female attractiveness, a lot of well-meaning advice regarding textiles will more or less have theoretical value only. Nevertheless, a series of simple but effective tips shall be mentioned in the following: Breathing cotton underwear is more appropriate than occlusive synthetic materials. Similar applies to the night that women should spend as often as possible without tightly fitting nightwear under the bedspread. Liners for underwear made of leak-proof plastic foil are a practical solution during the day but they are not breathing and support the heat and moisture build-up. Due to today's frequent removal of pubic hair, the sensitive areas get in direct and close contact with the textiles. This intensifies occlusive conditions for one thing and apart from that also involves that the partly protecting secretions are directly sponged up. Skin irritations often are the consequence. Prescriptions for oral antibiotics in the case of infections and all kinds of spermicidal contraceptives also can lead to disorders in the genital area. In the case of local irritations, sanitary pads are more appropriate than tampons. Special attention should be paid to cleansing and skin care routines during the hormonal changes due to puberty, ingestion of contraceptive pills, pregnancy and menopause as they affect the metabolism in the genital area. A tip for breastfeeding mothers: the oleogels based on phosphatidylcholine for the baby care do not contain any critical components and hence also are suitable for the breast care.